the big story

The great vaccine race: Who, when and where

The TLDR: There are at least 150 Covid-19 vaccines being developed by companies around the world. Of these, only 23 have reached the human trial stage. The company that wins this race will also determine who receives the vaccines first. Also: not everyone will benefit equally from a vaccine. We look at the predicted winners and where Indians will be on the inevitable waitlist.

Quick background: A vaccine is first tested on animals in a lab to see if it triggers an immune response and is safe to use on humans. It then goes through three phases of human trial—each with progressively larger samples of volunteers. The vaccine then has to be approved by each government’s regulatory agency before it can be distributed. We explained the process in greater detail here.

Which ones are ahead right now?

• The United States: Moderna will start Stage III human trials this month. The other big hitter is Pfizer which is testing four different versions of the vaccine in early human trials, but only one will advance to larger studies.
• The UK: The Oxford University vaccine—being developed in partnership with AstraZeneca—is generating the most buzz, and is already in Stage III trials in Brazil.
• China: Chinese company Sinovac Biotech has also been fast tracked to start Stage III trials in Brazil this month. 
• India: The big name closer to home is Covaxin—which is being developed by Bharat Biotech in association with the Indian Council of Medical Research. But it has just been approved for early human trials this month, and is behind the others in terms of testing.
• Russia: is the dark horse in the race. Its hackers have been accused of trying to steal vaccine research data from the US and UK. But Moscow claims it will roll out a vaccine as early as September. The world remains sceptical.

Ok, which ones do I care about?

Three vaccines are of most interest to Indians. Moderna because it will likely be the first to go to market. AstraZeneca because Pune-based Serum Institute has tied up with it to produce one billion doses of the vaccine—which will be distributed in low-income countries including India. And Bharat Biotech because it is the only ‘made in India’ vaccine that has reached the human trial stage. 

The Moderna vaccine

How does it work? Traditional vaccines inject live or dead bits of the virus into a human body—which then triggers the production of protective antibodies. This is how we become ‘immune’ when we get a jab. But Moderna is developing a unique messenger RNA (or mRNA) vaccine, which works like this:

• We are instead injected with genetic material taken from the virus.
• This teaches our cells to produce viral proteins—which are harmless in themselves.
• When our body detects these proteins, it launches the required immune response. 
• mRNA vaccines are faster and cheaper to produce because we don’t need large samples of the virus itself. 
• And the hope is that they will trigger not just antibodies, but also T-cells which kill the virus at the cellular level.

Has it worked? In phase one of human trials, 45 volunteers received one initial shot, and then a booster shot four weeks later—which triggered a “dramatic immune response.” The 100 mg dose caused mild side-effects such as fatigue, chills, headache, muscle pain, and pain at the site of injection. A stronger 250 mg dose caused a high fever in at least one of the volunteers, and has been set aside. Point to note: All volunteers “showed higher average antibody levels than were seen in patients who had recovered from Covid-19.”

The Oxford vaccine

How does it work? Scientists took a weakened version of the common cold virus from chimpanzees. They modified the virus so it can’t grow in humans. Then they added only the spike protein from the coronavirus—so that the human body detects its presence and mounts an immune response. 

Has it worked? Detailed results of early stage trials will be published today. But recent reports indicate that the jab provides “double protection”—i.e. volunteers produced not just antibodies but also T-cells (unlike Moderna). Why this matters: While antibodies may disappear within months—as had been widely reported among Covid recoveries—T-cells remain in the body for years.

Point to note: The team is also planning a controversial “human challenge” trial. This is when volunteers are exposed to live coronavirus in a lab setting in order to test the effectiveness of the vaccine.

The Bharat Biotech vaccine

How does it work? A person is injected with a dead sample of the virus, which in turn triggers an immune response. 

Does it work? We don’t know yet. Stage I human trials began on July 15 with 375 volunteers in India. The participants will receive two shots, fourteen days apart.

Which one will be ready first?

Timelines are all over the place, and subject to media hype and political pressure—one feeding the other. Indian authorities were recently caught pressuring hospitals to meet a highly unrealistic August 15 deadline for Covaxin (explained here). UK officials claim the Oxford vaccine will be “fairly widely available around September.” Moderna is the most cautious: “Our goal is to have a vaccine available for broad distribution by year-end or early next year." But it could be approved for emergency use far earlier. All things considered, the best bet is the Oxford vaccine.

So when will Indians get a vaccine?

AstraZeneca has already committed to supplying 100 million doses of the Oxford vaccine to Britain by September/October. It will also provide the US with 300 million doses. The company’s India partner, Serum Institute, says “a safe and good vaccine for India and the world… is still at least six months away”—and it hopes to produce 400 million doses by December for India and other low-income countries.

When it comes to access, virologist Klaus Stohr sums it up best:

“It may be clear that only those who will have vaccine production on their soil will have access to vaccines during the pandemic. I hope it’s not going to turn out this way, but I fear it will.”

The bottomline: India manufactures 60-70% of the world’s vaccines. And Bill Gates predicts that we will be able to supply an effective vaccine not just for India but the entire world.

Reading list

Of the many things to read out there, we most strongly recommend: 

• New York Times’ infographic offers an excellent overview of the vaccine race in a glance. 
• Reuters’ profiles the Serum Institute and its critical role in the race for the virus. 
• BBC News’ timeline details the long road before everyone can be vaccinated, and the pandemic can finally be put to an end. 
• Bloomberg News has a must-read interview with virologist Klaus Stohr. 
• The Wire lays out how global inequalities will play out in determining who gets the vaccine and when.
• National Geographic explains why older people are least likely to benefit from a vaccine—because of the way age affects our immune system.